Governance: No Wrong Door State of Connecticut

“ ” Governance determines who has power, who makes decisions, how other players make their voice heard and how account is rendered. Institute on Governance Ultimately, the application of good governance serves to realize organizational and societal goals

VISION Connecticut residents have access to a full range of high-quality long-term care options that maximize autonomy, choice and dignity. Health Exchange Private Health and Social Supports- Public Health and Social Supports - Local Integrated – Person Centered Options for telephonic or 1:1 assistance Strategy Streamline access by: Maximizing information technology Standardizing assessments Building NWD access points in each community

Governor Malloy Office of Policy and Management Department of Mental Health and Addiction Services Department of Developmental Services Department of Social Services Division of Health Services Rebalancing Initiatives Alternate Care Administrative Service Organizations State Department of Aging Department of Public Health Department of Rehabilitative Services

Governance Strategy  Systems Level - Readiness for Change  Identifying Stakeholders with Common Vision/Mission  Identification of Leverage Points  Identification of Circles of Influence

2010 – 2014 Affordable Care Act Deficit Reduction Act 2000 – 2004 Real Choice Systems Change Olmstead Decision ADA Complex Care Committee 2010 – 2014 Council on Medicaid Program Oversight LTC Planning Committee includes people with disabilities 2000 – 2004 Long Term Care Planning Committee and Advisory Committee Medical Assistance Oversight Council 2010 – 2014 MFP Steering Committee – expands to include rebalancing (NWD) NF Steering Committee becomes MFP Steering Committee; ADRC 2000 – 2004 Olmstead Task Force; Nursing Facility Transition Steering Committee Federal Level Connecticut State Statutes Connecticut Executive Branch with no Legislation

MFP Rebalancing Steering Committee BylawsNominating Hospital Discharge Evaluation Workforce Development Global Communications Chaired by ADRC Project Director Housing

Money Follows the Person Steering Committee  Bylaws - Voting Members ….20 – 30 voting members who demonstrate commitment to ‘Rebalancing’ and to the philosophy of Self- Determination and Independent Living ….  Monthly Meetings  Providers may participate on workgroups but not on the Committee  Co-chaired: Executive Director Commission on Aging and Past National President of the ARC.  Members of each state agency (see org chart), people with disabilities, family members, nursing home administrator, advocacy organizations (AARP, MS Society, NAMI, etc.)

History of ADRCs in CT All 5 AAAs, CILSs & CCCI Focus shifts from ADRC Program to NWD System Sept 2012 CT receives Enhanced OC Grant – achieves statewide ADRC coverage Sept 2009 CT receives 1st official ADRC grant 3 rd formed Sept 2007 CT receives NHD Grant forms 1 st ADRCs June 2007 SDA hosted ADRC Planning Meeting Early 2000’s CT applies for & does not receive initial round ADRC grants Included state stakeholders, ACL and Lewin Group

ADRC Oversight Structure Statewide ADRC Committee  ADRC Operating Protocol Workgroup  ADRC Planning Workgroup  ADRC Training Workgroup  ADRC Private Pay Workgroup  ADRC Marketing Materials Workgroup  ADRC Data & Outcomes Workgroup Regional Partners Workgroups and Advisory Councils  5 AAAs; 5 CILs and CCCI (in 2 regions) – Same partners also MFP contractors  Regionals Stakeholders & Consumers

NWD Stakeholder Engagement: Visibility & Trust  MFP Steering Committee includes members of each state agency (see org chart), people with disabilities, family members, nursing home administrator, advocacy organizations (AARP, MS Society, NAMI, etc.)  ADRC Statewide Committee also includes members of state agencies, community organizations, advocacy organizations and consumers  Regional ADRC Workgroups include the regional stakeholders such as AAA/CIL boards, consumers, local community partners, municipalities. Varies by region.  ADRCs identified critical pathways in each region and conducted outreach efforts and developed I&R protocols where possible

Strengths and Challenges Strengths  51% persons with disabilities and/or family members  Organizational structure  Shared leadership  Conflict free Challenges  Finding the right people  Providing information in an actionable format  Strategic coordination with other groups working on similar goals  Assuring integrated approach  Communication  Diversion & Serving non-Medicaid Population

Commitment to Strengthen CT NWD  Focus on strategic coordination with other groups working on similar goals Further define niche of ADRCs in CT’s NWD system (i.e. 1:1 assistance, PCP) Examine and define role of SDA: Where does aging population fit outside of CHCPE? OAA programs, Wellness/Prevention programs; ADRC  Examine and re-envision ADRCs in the context of a NWD system Maintaining existing ADRC partners while growing broader vision  More attention to Non-Medicaid population  Create Access Points in local communities